Free Falling: Declining Inflation-Adjusted Payment for Arthroplasty Surgeons

Over the past decade, there have been ongoing concerns over declining surgeon compensation for lower extremity arthroplasty. We aimed to determine changes in surgeon payment, patient charges, and overall reimbursement rates for patients undergoing unicompartmental arthroplasty (UKA) and both primary and revision total knee (TKA) and hip (THA) arthroplasty.

Using Medicare data from 2012 to 2017, we determined inflation-adjusted changes in annual surgeon payment (professional fee), patient charges, and reimbursement rate (payment-to-charge ratio) for UKA and primary/revision TKA and THA. Both nonweighted and weighted (by procedure frequency/volume) means were calculated.

Inflation-adjusted surgeon payment decreased for all procedures analyzed, with primary TKA (−17%) and THA (−11%) falling the most. Payment for UKA increased the most (+30%). There was a small increase in charges for THA revision (+2.2%, +2.1%, and +3.2% for acetabulum only, femur only, and both components, respectively). Charges for primary TKA (−3.7%) and THA (−1.5%) decreased slightly. The reimbursement rate for all procedures fell with UKA (−15%), TKA (−14%), and THA (−10%) falling the most. After weighting by procedure frequency/volume and combining all surgeries, average charges fell slightly (−0.7%), whereas surgeon payment (−13%) and reimbursement rate (−12%) fell more sharply.

Although patient charges have grown in pace with the inflationary rate for primary and revision TKA and THA, surgeon payment and reimbursement rates have fallen sharply. The orthopedic community needs to be aware of these financial trends to communicate to payers and health care policy makers the importance of protecting a sustainable payment infrastructure.